How to Prevent Healthcare-associated Infection by Determining Risk
Although the focus of the medical and non-medical world is currently on Coronavirus preparation, many issues that have been perennial concerns of healthcare remain important, and some have even been made more urgent by the unique circumstances. One of these issues is that of Healthcare-associated Infection in hospitals, clinics, and doctors’ offices.
Consider:
- On average, one out of every 31 hospital patients is diagnosed with at least one healthcare-associated infection (HAI) on any given day.
- HAIs account for an estimated 1.7 million infections per year.
- More than 99,000 HAI-associated deaths occur annually.
These facts are hardly surprising when one considers the number of potentially contaminated surfaces and the people who touch them in a healthcare setting. Take, for example, a single bedrail that is touched by a sick patient, raised by a nurse, brushed against by a doctor’s coat, adjusted by a visitor, lowered by an X-ray technician, and, finally—we hope—cleaned and disinfected by an EVS worker.
According to the CDC, “Cleaning and disinfection of environmental surfaces are fundamental to reduce potential contribution to HAIs.” Yet with so many surfaces to attend to, how does the average EVS team determine which ones need to be cleaned versus disinfected and how often—information vital to efficiently work loading any healthcare facility? The answer lies in assessing the surface’s risk.
Determining the Risk of Healthcare-associated Infection
“The determination of environmental cleaning procedures for individual patient care areas, including frequency, method, and process, should be based on the risk of pathogen transmission,” states the CDC.
Determining risk is especially important when it comes to disinfecting to assure the process is performed properly on surfaces where it is warranted as well as to prevent the use of these harsher chemicals in areas where they are not necessary and could conceivably do patients more harm than good.
In healthcare settings, the CDC has established guidelines for determining contamination risk based on three factors:
Probability—how likely the surface is to be exposed to potentially infectious pathogens.
Vulnerability—how susceptible to infection are the patients who are likely to come in contact with the surface.
Exposure—how great a chance is there for the surface to be exposed to pathogens (high-touch vs. low-touch surfaces).
By delving deeper into these three areas and using CDC guidelines, we can categorize the level of risk for each surface.
Probability
The risk associated with surfaces in healthcare settings can be divided into three basic levels of probable contamination and assigned a number accordingly.
High risk is surfaces that are regularly exposed to blood and other bodily fluids, such as those in surgical, emergency, birthing, autopsy, and similar rooms. High-risk surfaces earn a 3.
Moderate risk includes surfaces that are not routinely but may be exposed to bodily fluids that have been removed or contained, such as wet sheets or spilled blood vials. Restrooms and patient rooms should always be classified as at least moderate risk. These surfaces are assigned a risk factor of 2.
Light risk would be general areas that do not have surfaces exposed to blood or other bodily fluids, such as offices or lounge areas. These have a risk factor of 1.
Vulnerability
Here, there are two risk categories:
High susceptibility to infection includes all those surfaces in areas used by patients with compromised immune systems, such as oncology, surgery, recovery, nurseries, chemotherapy, etc. and are given a risk factor of 1
Low susceptibility includes all other patients/areas and gets a zero.
Exposure
High-touch surfaces— from bed rails and call buttons to restroom fixtures and light switches—require frequent cleaning and disinfection, so they receive a risk factor of 3.
Low-touch surfaces are far less-handled, such as walls and ceilings, and score a 1.
Tallying the Risk
Once you’ve got the surface areas placed in the right risk buckets, you can do what is called a Risk Stratification Score, which is a fancy way of saying add up the scores to determine the total risk.
For example, the risk for a high-touch surface is 3. So If you have a high-probability and high-susceptibility surface, your total risk score will be 7 (3+3+1). Or, If the surface has a moderate probability of contamination but high susceptibility, you will get a total score of 6 (3 +2 +1).
Similarly, with a low-touch surface, you will start off with 1, adding to it the surface’s probability and susceptibility scores.
From here, it is simply a question of relying on the CDC guidelines for determining healthcare cleaning frequencies listed below.
| Risk Type | Minimum Cleaning Frequency | |
| 7 | High Risk | Clean after each case/event/procedure and clean additionally as required |
| 4–6 | Moderate Risk | Clean at least once daily Clean additionally as required (e.g., gross soiling) |
| 2–3 | Low Risk | Clean according to a fixed schedule Clean additionally as required (e.g., gross soiling) |
When it comes to fighting HAIs and infection prevention, it pays to know your risks.
Need a Healthcare-associated Infection Audit?
At Allynt Solutions, we offer a comprehensive suite of cleaning and disinfecting audits custom-tailored to your business. Especially during the trying times of Covid, but also during the return to normality afterward, making sure the processes you follow are OSHA and CDC-compliant is of the utmost importance. Our process audits can make sure that your employees are following CDC best practices for disinfecting surfaces and preventing Healthcare-associated Infections, and we can work with you from there to make a plan of action moving forward. There has never been a better time to get a cleaning and disinfecting audit done, so contact Allynt Solutions today!
